Submit Claim ? Contents | X Close Window

This form allows you to add a series of claims and process them all at once. Enter a claim and press the 'Add' button. Once you have finished adding all of your claims, press the 'Continue' button to view a confirmation screen. You will then be instructed to finish the process and will be offered a FAX cover sheet for this series of claims. Press 'Cancel' at anytime to clear the list of claims without submitting. Your claims are not saved until you finish this process.